In 2002, the National Institute of Diabetes & Digestive & Kidney Diseases convened the first Bladder Progress Review Group to the examine research needs related to bladder conditions. Their executive summary identified urinary incontinence as a condition especially in need of research and recommended new research initiatives to "Improve understanding of the mechanisms of urinary incontinence" and to "Develop preventive and therapeutic approaches to urinary incontinence that are sensitive to gender, race and culture and develop the means of measuring outcomes for treatment." For women with urinary incontinence, it is essential that outcomes assessments be expanded beyond the traditional measures of "cure, improved, or unchanged." The newly validated Incontinence Symptom Index (ISI) is a practical, 10-item, patient self-administered symptom severity measure designed to assess urinary incontinence outcomes in both the clinical and research settings. Existing tools are typically lengthy and burdensome; thus, they are applied only in the research setting where patient selection is often restricted. Although this provides excellent scientific evidence, generalizability is often limited. The goal of this project is to apply the ISI, a pragmatic clinical and research tool, to identify intervention-specific, physiological/anatomic and racial determinants of urinary incontinence natural history and outcome. This wilt be achieved through three specific aims that will encompass both a clinical and a community based sample of women. Specific aim 1 will apply the ISI in a multidisciplinary clinical setting and assess the effects of a broad range of interventions on the severity of urinary incontinence and the type of symptoms. Specific aim 2 will examine the relationships between anatomic and physiologic factors with the severity of urinary incontinence as measured by the ISI. Finally, specific aim 3 will examine the longitudinal changes in urinary incontinence symptom severity over a 4-year period and compare the natural history between White and African American women. The findings from this project will facilitate patient counseling by providing valid estimates of outcomes using a standardized tool and will provide direction for the next sets of studies to better define the treatment options, clinical course and racial disparities in urinary incontinence.